Corneal ulcers associated with extended-wear soft contact lenses

We treated nine myopic and nine aphakic eyes in patients who developed corneal ulcers while wearing extended-wear soft contact lenses. Bacteria were recovered from the corneal ulcers of 13 of 18 patients with Pseudomonas aeruginosa being the pathogen most frequently isolated. Chemical disinfection was used by seven of the nine patients with myopia and eight of the nine with aphakia. Two of nine patients in the myopic group had visual loss to 20/200 and hand movements; five of nine patients in the aphakic group had visual loss to 20/50 or worse. Invasion of the corneal stroma by bacteria may occur after breakdown of the epithelial barrier by contact lens manipulation or after chronic overnight anoxic stress. Thus, the use of soft contact lenses on an extended-wear basis may be complicated by the development of corneal ulcers. Both aphakic and myopic eyes are at risk.